ABSTRACT
Quality controls are becoming an important part of our health care system. A medical audit is one way of evaluating quality of care, and this paper describes the results of an audit conducted to investigate the reasons for a prolonged stay on a psychiatric inpatient unit. The results showed a decrease in the mean length of stay over a five year period, although the figure remained substantially above provincial norms. A review of the hospital charts of a random sample of one in six patients whose hospital stay exceeded 30 days was carried out. It revealed that in 50.0% of cases the reasons were "medically acceptable," in 10.3% the reasons were "medically unacceptable" and in 39.7% the reasons were "social and administrative" and beyond the control of the treating psychiatrist. The implication of these results are discussed.
Subject(s)
Community Mental Health Services , Health Services Misuse , Hospitalization , Medical Audit , Mental Disorders/therapy , Adult , Chronic Disease , Combined Modality Therapy , Depressive Disorder/psychology , Depressive Disorder/therapy , Female , Hospitals, General , Humans , Male , Mental Disorders/psychology , Middle Aged , Mood Disorders/psychology , Mood Disorders/therapy , Ontario , Personality Disorders/psychology , Personality Disorders/therapy , Psychiatric Department, Hospital , Psychotic Disorders/psychology , Psychotic Disorders/therapy , Quality Assurance, Health CareABSTRACT
A patient with unipolar affective disorder developed elevations in her liver enzymes shortly after initiation of therapy with maprotiline. The enzyme levels rapidly returned to normal after cessation of the drug with no residual liver disease.
Subject(s)
Anthracenes/adverse effects , Chemical and Drug Induced Liver Injury/etiology , Depressive Disorder/drug therapy , Maprotiline/adverse effects , Female , Humans , Liver Function Tests , Maprotiline/therapeutic use , Middle AgedSubject(s)
Peer Review , Quality of Health Care , Canada , Confidentiality , Cost-Benefit Analysis , Humans , Informed ConsentSubject(s)
Hospitals, Teaching/statistics & numerical data , Hospitals, University/statistics & numerical data , Mental Disorders/therapy , Outpatient Clinics, Hospital/statistics & numerical data , Psychiatric Department, Hospital/statistics & numerical data , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , OntarioSubject(s)
Mental Disorders/epidemiology , Psychiatric Department, Hospital , Adolescent , Adult , Aged , Female , Hospitals, General , Hospitals, University , Humans , Male , Middle Aged , Ontario , Suicide, Attempted/epidemiologyABSTRACT
Evoked potential indices of an early and late stage of attentional processing were recorded from schizophrenic and normal subjects during dichotic listening tasks. Despite slow and inaccurate detections, the schizophrenic subjects were able to focus selectively to different ears but only at a fast stimulation rate, showing integrity of the early selective stage. They showed an abnormal late stage, indicating inefficiency in processing information from detected targets. Marked deficits at a slow stimulation rate and during divided attention suggest that the schizophrenic attention disorder is one of control and maintenance of a selective processing strategy rather than of general slowness or absence of selectivity.
Subject(s)
Attention/physiology , Brain/physiopathology , Schizophrenia/physiopathology , Auditory Perception , Evoked Potentials , HumansSubject(s)
Death , Education, Medical , Thanatology , Canada , Curriculum , Evaluation Studies as Topic , HumansSubject(s)
Attitude to Death , Terminal Care/psychology , Child , Denial, Psychological , Family , HumansABSTRACT
In a brief expose, the author wants to integrate the psychoanalytic data towards a better clinical use of psychopharmacology. Starting from a triadic situation "patient-physician-medication", he proposes a dynamic rather than a static attitude in the patient's approach, aiming at an eventual diadic relation "patient-physician" and, if at all possible, a relative or total independance of the patient. After alluding at the role of the physician, of the patient and of the medication, in such a process, the author refers to intra and extra psychic influence in disease. The concepts of "team approach" and "milieu therapy" are related to the key-role of the psychiatrist and to the availability of competent and well-motivated paramedical professionals in sufficient numbers. The notions of transference, countertransference and control as well as the symbolic of the symptoms are briefly outlined. The author concludes that the complementary elements of psychoanalysis and psychopharmacology will benefit the patient if the clinician knows how to integrate them along with the changing and dynamic process of the illness.
Subject(s)
Mental Disorders/therapy , Psychopharmacology , Psychotherapy , Humans , Occupational Therapy , Physician-Patient RelationsABSTRACT
PIP: A questionnaire was distributed through pharmacists to French-Canadian users of oral contraceptives to study their sexual adaptation and psychological changes. The response rate was 12%, yielding 114 questionnaires. 40% answered "no change," but more noted improvement than worsening in sexual desire, frequency, and satisfaction. In a group designated "frigid" (those who answered rarely or never to an undisclosed question) 38.5-61.5% reported increased desire; and 20-55% reported increased satisfaction. 42.85% noted physical side effects, which correlated with satisfaction of the method. 34.7% claimed psychological side effects such as anxiety, irritability or fatigue, which correlated with dissatisfaction with the method. The authors hypothesized that physical effects like weight-gain, breast enlargement, and pseudopregnancy unconsciously supplement the conscious relief from fear of pregnancy to improve sexual adaptation.^ieng
